Radiofrequency Catheter Ablation of Ventricular Tachycardia in a Military Parachuter

Abstract

Premature ventricular contractions (PVCs) presenting as isolated complexes are insignificant, but if they present as salvos they are considered indicators of high risk for potentially fatal arrhythmias. We present the case of a 39-yr-old male military parachuter with PVCs and ventricular tachycardia that were incidentally detected on ECG and treated with radiofrequency catheter ablation (RFCA). He had no significant past medical history. Physical examination and biochemical tests were normal. Transthoracic echocardiography showed no structural heart disease. Due to frequent ventricular extrasystoles (VES) detected on his ECG, 24-h Holter monitoring was conducted and revealed VES, including 13,351 isolated PVCs, 1427 episodes of bigeminy, 397 of trigeminy, 30 couplets, and 4 salvo periods. After beta-blocker and calcium channel blocker treatment for 1 mo, his repeat 24-h Holter monitoring showed 18,414 isolated PVCs, 819 episodes of bigeminy, 181 of trigeminy, and 6 couplet VES, but no episodes of salvos. Electrophysiological studies (EPS) were performed and the baseline measurements were: basic cycle length: 890 ms; atrium His interval: 78 ms; and ventricular His interval: 54 ms. VES were found to orginate from the right ventricular outflow tract and were terminated by RFCA. Medical treatment was stopped. Repeat Holter showed no VES. The parachuter was qualified for full duties. As the patient is an aircrew member and further usage of antiarrhythmic agents will interfere with his flying status, instead of initiating a drug therapy again, we performed EPS and RFCA as an effective and dependable method in order to treat and to determine his fitness.